Resuscitation Technology

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Brief set of slides discussing mechanical CPR, adjuncts to enhance circulation, and hypothermia.

Brief set of slides discussing mechanical CPR, adjuncts to enhance circulation, and hypothermia.

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  • A variety of CPR techniques and devices may improve hemodynamics or short-term survival when used by well trained providers in selected patients. To date no adjunct has consistently been shown to be superior to standard manual CPR for out-of-hospital basic life support, and no device other than a defibrillator has consistently improved long-term survival from out-of-hospital cardiac arrest.
  • It is reasonable to perform procedure/administer treatment or perform diagnostic test/ assessment. Procedure/treatment or diagnostic test/assessment may be considered.
  • The impedance threshold device (ITD) is a valve that limits air entry into the lungs during chest recoil between chest compressions. It is designed to reduce intrathoracic pressure and enhance venous return to the heart. In initial studies the ITD was used with a cuffed endotracheal tube during bagtube ventilation and ACD-CPR.42–44 The ITD and ACD device are thought to act synergistically to enhance venous return during active decompression. In recent reports the ITD has been used during conventional CPR45,46 with an endotracheal tube or face mask. Studies suggest that when the ITD is used with a face mask, it may create the same negative intratracheal pressure as use of the ITD with an endotracheal tube if rescuers can maintain a tight face mask seal.43,45,46 In 2 randomized studies (LOE 1)44,47 of 610 adults in cardiac arrest in the out-of-hospital setting, use of ACD-CPR plus the ITD was associated with improved ROSC and 24-hour survival rates when compared with use of standard CPR alone. A randomized study of 230 adults documented increased admission to the intensive care unit and 24-hour survival (LOE 2)45 when an ITD was used during standard CPR in patients in cardiac arrest (pulseless electrical activity only) in the out-of-hospital setting. The addition of the ITD was associated with improved hemodynamics during standard CPR in 1 clinical study (LOE 2).46 Although increased long-term survival rates have not been documented, when the ITD is used by trained personnel as an adjunct to CPR in intubated adult cardiac arrest patients, it can improve hemodynamic parameters and ROSC (Class IIa).
  • Mechanical Piston Device The mechanical piston device depresses the sternum via a compressed gas-powered plunger mounted on a backboard. In 1 prospective randomized study and 2 prospective randomized crossover studies in adults (LOE 2),48–50 mechanical piston CPR used by medical and paramedical personnel improved end-tidal CO2 and mean arterial pressure in patients in cardiac arrest in both the out-of-hospital and in-hospital settings. Mechanical piston CPR may be considered for patients in cardiac arrest in circumstances that make manual resuscitation difficult (Class IIb). The device should be programmed to deliver standard CPR with adequate compression depth at the rate of 100 compressions per minute with a compression ventilation ratio of 30:2 (until an advanced airway is in place) and a compression duration that is 50% of the compressiondecompression cycle length. The device should allow complete chest wall recoil.
  • Load-Distributing Band CPR or Vest CPR The load-distributing band (LDB) is a circumferential chest compression device composed of a pneumatically or electri-cally actuated constricting band and backboard. Evidence from a case control study of 162 adults (LOE 4)51 documented improvement in survival to the emergency department when LDB-CPR was administered by adequately trained rescue personnel to patients with cardiac arrest in the out-of-hospital setting. The use of LDB-CPR improved hemodynamics in 1 in-hospital study of end-stage patients (LOE 3)52 and 2 laboratory studies (LOE 6).53,54 LDB-CPR may be considered for use by properly trained personnel as an adjunct to CPR for patients with cardiac arrest in the out-of-hospital or in-hospital setting (Class IIb).

Transcript

  • 1. Resuscitation Technology These slides discuss Class IIa and IIb recommendations from the American Heart Association Guidelines for CPR and ECC. In no way should they be considered endorsement by the American Heart Association.
  • 2.
    • Technology will
    • continue to be a part
    • of the solution.
    • Incremental benefits
    • are significant,
    • particularly when
    • combined.
    Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
  • 3.
    • Challenges to the performance of quality
    • chest compressions with minimal interruptions
    Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
  • 4. Classification
  • 5. Impedance Threshold Device Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers. … used by trained personnel as an adjunct to CPR in intubated adult cardiac arrest patients, it can improve hemodynamic parameters and ROSC (Class IIa).
  • 6. Mechanical Piston Device Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers. Mechanical piston CPR may be considered for patients in cardiac arrest in circumstances that make manual resuscitation difficult (Class IIb).
  • 7. Load Distributing Band Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers. LDB-CPR may be considered for use by properly trained personnel as an adjunct to CPR for patients with cardiac arrest in the out-of-hospital or in-hospital setting (Class IIb).
  • 8. Well Batman, we all know it’s cool to be cool these days.
  • 9. To Cool is to be Cool Unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation (VF). Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.